To whatever extent home health providers felt left out of the value-based care developments of recent years, their time has come. On Jan. 1, 2020, the Centers for Medicare and Medicaid Services will implement the Patient-Driven Groupings Model (PDGM), which will make wholesale changes to the way home health is reimbursed.

Here’s a glimpse at some of the big changes coming:

  • Shorter episodes of care: The current system pays for 60-day episodes of care. PDGM changes the unit of payment to one or two 30-day periods of care.
  • More payment groupings: The current system allows for 153 potential unique case-mix groups. PDGM increases this number to 432 combinations.
  • Increased claims volume: Because two 30-day payment episodes are replacing a single 60-day one, home health providers can expect to see an influx of claims and Requests for Anticipated Payments (RAPs).

For a comprehensive look at the changes under PDGM, check out this presentation from the Medicare Learning Network

PDGM is expected to be revenue-neutral for home health agencies, but the changeover underscores the importance of having robust billing tools to ensure clean claims, manage denials, streamline workflows and prioritize accounts.

But some post-acute care providers are discovering that the majority of healthcare revenue cycle solutions weren’t built for their multi-facility operations. Disparate systems make it hard for them to aggregate data and get a complete picture of A/R.

Does that sound like your post-acute care organization? Don’t worry, we’re not going to suggest that you transition to a single billing system for your facilities. But we do suggest that you carefully consider what impact your current billing and follow up software tools may have once these changes go into effect, and work to identify any gaps that you may have. There may be areas of opportunity for your organization to employ intelligent automation or adopt a more streamlined workflow application to better monitor financial impact. Contact Laurie Pomerantz, vice president of business development, at laurie.pomerantz@gaffeyhealth.com to learn more.